Cosmetic neurotoxin compositions and methods

ABSTRACT

Cosmetic compositions include a Clostridial neurotoxin component and a microsphere component. In certain compositions, the composition includes a botulinum toxin and a plurality of swellable microspheres. The compositions are administered to individuals, by injection and the like, to treat a cosmetic defect of deficiency.

BACKGROUND

The present invention relates to cosmetic compositions and methods forusing such compositions to enhance cosmetic features of an individual,such as the use of such compositions to treat skin contour deficiencies,including wrinkles, of an individual.

Skin Contour Deficiencies

For a variety of reasons, damage to the skin often results in skincontour deficiencies and other skin anomalies, including wrinkles. Inorder to correct contour deficiencies and other anomalies of the skin,people often resort to cosmetic surgery, such as face lifts and skintucks and/or injection of various materials, such as collagen, silicone,and solid microparticles. U.S. Pat. No. 6,436,424 discloses injectableand swellable microspheres for dermal augmentation. Liquid compositionscontaining botulinum toxin have been used to treat wrinkles.

Botulinum Toxin

The genus Clostridium has more than one hundred and twenty sevenspecies, grouped according to their morphology and functions. Theanaerobic, gram positive bacterium Clostridium botulinum produces apotent polypeptide neurotoxin, botulinum toxin, which causes aneuroparalytic illness in humans and animals referred to as botulism.The spores of Clostridium botulinum are found in soil and can grow inimproperly sterilized and sealed food containers of home basedcanneries, which are the cause of many of the cases of botulism. Theeffects of botulism typically appear 18 to 36 hours after eating thefoodstuffs infected with a Clostridium botulinum culture or spores. Thebotulinum toxin can apparently pass unattenuated through the lining ofthe gut and attack peripheral motor neurons. Symptoms of botulinum toxinintoxication can progress from difficulty walking, swallowing, andspeaking to paralysis of the respiratory muscles and death.

Botulinum toxin type A is the most lethal natural biological agent knownto man. About 50 picograms of a commercially available botulinum toxintype A (purified neurotoxin complex)¹ is a LD50 in mice (i.e. 1 unit).One unit of BOTOX® contains about 50 picograms (about 56 attomoles) ofbotulinum toxin type A complex. Interestingly, on a molar basis,botulinum toxin type A is about 1.8 billion times more lethal thandiphtheria, about 600 million times more lethal than sodium cyanide,about 30 million times more lethal than cobra toxin and about 12 milliontimes more lethal than cholera. Singh, Critical Aspects of BacterialProtein Toxins, pages 63-84 (chapter 4) of Natural Toxins II, edited byB. R. Singh et al., Plenum Press, New York (1976) (where the stated LD50of botulinum toxin type A of 0.3 ng equals 1 U is corrected for the factthat about 0.05 ng of BOTOX® equals 1 unit). One unit (U) of botulinumtoxin is defined as the LD50 upon intraperitoneal injection into femaleSwiss Webster mice weighing 18 to 20 grams each.¹ Available from Allergan, Inc., of Irvine, Calif. under the tradenameBOTOX® in 100 unit vials)

Seven generally immunologically distinct botulinum neurotoxins have beencharacterized, these being respectively botulinum neurotoxin serotypesA, B, C1, D, E, F and G each of which is distinguished by neutralizationwith type-specific antibodies. The different serotypes of botulinumtoxin vary in the animal species that they affect and in the severityand duration of the paralysis they evoke. For example, it has beendetermined that botulinum toxin type A is 500 times more potent, asmeasured by the rate of paralysis produced in the rat, than is botulinumtoxin type B. Additionally, botulinum toxin type B has been determinedto be non-toxic in primates at a dose of 480 U/kg which is about 12times the primate LD50 for botulinum toxin type A. Moyer E et al.,Botulinum Toxin Type B: Experimental and Clinical Experience, beingchapter 6, pages 71-85 of “Therapy With Botulinum Toxin”, edited byJankovic, J. et al. (1994), Marcel Dekker, Inc. Botulinum toxinapparently binds with high affinity to cholinergic motor neurons, istranslocated into the neuron and blocks the release of acetylcholine.Additional uptake can take place through low affinity receptors, as wellas by phagocytosis and pinocytosis.

Regardless of serotype, the molecular mechanism of toxin intoxicationappears to be similar and to involve at least three steps or stages. Inthe first step of the process, the toxin binds to the presynapticmembrane of the target neuron through a specific interaction between theheavy chain, H chain, and a cell surface receptor; the receptor isthought to be different for each type of botulinum toxin and for tetanustoxin. The carboxyl end segment of the H chain, HC, appears to beimportant for targeting of the toxin to the cell surface.

In the second step, the toxin crosses the plasma membrane of thepoisoned cell. The toxin is first engulfed by the cell throughreceptor-mediated endocytosis, and an endosome containing the toxin isformed. The toxin then escapes the endosome into the cytoplasm of thecell. This step is thought to be mediated by the amino end segment ofthe H chain, HN, which triggers a conformational change of the toxin inresponse to a pH of about 5.5 or lower. Endosomes are known to possess aproton pump which decreases intra-endosomal pH. The conformational shiftexposes hydrophobic residues in the toxin, which permits the toxin toembed itself in the endosomal membrane. The toxin (or at a minimum thelight chain) then translocates through the endosomal membrane into thecytoplasm.

The last step of the mechanism of botulinum toxin activity appears toinvolve reduction of the disulfide bond joining the heavy chain, Hchain, and the light chain, L chain. The entire toxic activity ofbotulinum and tetanus toxins is contained in the L chain of theholotoxin; the L chain is a zinc (Zn++) endopeptidase which selectivelycleaves proteins essential for recognition and docking ofneurotransmitter-containing vesicles with the cytoplasmic surface of theplasma membrane, and fusion of the vesicles with the plasma membrane.Tetanus neurotoxin, botulinum toxin types B, D, F, and G causedegradation of synaptobrevin (also called vesicle-associated membraneprotein (VAMP)), a synaptosomal membrane protein. Most of the VAMPpresent at the cytoplasmic surface of the synaptic vesicle is removed asa result of any one of these cleavage events. Botulinum toxin serotype Aand E cleave SNAP-25. Botulinum toxin serotype C1 was originally thoughtto cleave syntaxin, but was found to cleave syntaxin and SNAP-25. Eachof the botulinum toxins specifically cleaves a different bond, exceptbotulinum toxin type B (and tetanus toxin) which cleave the same bond.Each of these cleavages block the process of vesicle-membrane docking,thereby preventing exocytosis of vesicle content.

Botulinum toxins have been used in clinical settings for the treatmentof neuromuscular disorders characterized by hyperactive skeletal muscles(i.e. motor disorders). In 1989 a botulinum toxin type A complex hasbeen approved by the U.S. Food and Drug Administration for the treatmentof blepharospasm, strabismus and hemifacial spasm. Subsequently, abotulinum toxin type A was also approved by the FDA for the treatment ofcervical dystonia and for the treatment of glabellar lines, and abotulinum toxin type B was approved for the treatment of cervicaldystonia. Non-type A botulinum toxin serotypes apparently have a lowerpotency and/or a shorter duration of activity as compared to botulinumtoxin type A. Clinical effects of peripheral intramuscular botulinumtoxin type A are usually seen within one week of injection. The typicalduration of symptomatic relief from a single intramuscular injection ofbotulinum toxin type A averages about three months, althoughsignificantly longer periods of therapeutic activity have been reported.

Although all the botulinum toxins serotypes apparently inhibit releaseof the neurotransmitter acetylcholine at the neuromuscular junction,they do so by affecting different neurosecretory proteins and/orcleaving these proteins at different sites. For example, botulinum typesA and E both cleave the 25 kiloDalton (kD) synaptosomal associatedprotein (SNAP-25), but they target different amino acid sequences withinthis protein. Botulinum toxin types B, D, F and G act onvesicle-associated protein (VAMP, also called synaptobrevin), with eachserotype cleaving the protein at a different site. Finally, botulinumtoxin type C1 has been shown to cleave both syntaxin and SNAP-25. Thesedifferences in mechanism of action may affect the relative potencyand/or duration of action of the various botulinum toxin serotypes.Apparently, a substrate for a botulinum toxin can be found in a varietyof different cell types. See e.g. Biochem J 1; 339 (pt 1):159-65:1999,and Mov Disord, 10(3):376:1995 (pancreatic islet B cells contains atleast SNAP-25 and synaptobrevin).

The molecular weight of the botulinum toxin protein molecule, for allseven of the known botulinum toxin serotypes, is about 150 kD.Interestingly, the botulinum toxins are released by Clostridialbacterium as complexes comprising the 150 kD botulinum toxin proteinmolecule along with associated non-toxin proteins. Thus, the botulinumtoxin type A complex can be produced by Clostridial bacterium as 900 kD,500 kD and 300 kD forms. Botulinum toxin types B and C1 is apparentlyproduced as only a 700 kD or 500 kD complex. Botulinum toxin type D isproduced as both 300 kD and 500 kD complexes. Finally, botulinum toxintypes E and F are produced as only approximately 300 kD complexes. Thecomplexes (i.e. molecular weight greater than about 150 kD) are believedto contain a non-toxin hemaglutinin protein and a non-toxin andnon-toxic nonhemaglutinin protein. These two non-toxin proteins (whichalong with the botulinum toxin molecule comprise the relevant neurotoxincomplex) may act to provide stability against denaturation to thebotulinum toxin molecule and protection against digestive acids whentoxin is ingested. Additionally, it is possible that the larger (greaterthan about 150 kD molecular weight) botulinum toxin complexes may resultin a slower rate of diffusion of the botulinum toxin away from a site ofintramuscular injection of a botulinum toxin complex.

In vitro studies have indicated that botulinum toxin inhibits potassiumcation induced release of both acetylcholine and norepinephrine fromprimary cell cultures of brainstem tissue. Additionally, it has beenreported that botulinum toxin inhibits the evoked release of bothglycine and glutamate in primary cultures of spinal cord neurons andthat in brain synaptosome preparations botulinum toxin inhibits therelease of each of the neurotransmitters acetylcholine, dopamine,norepinephrine (Habermann E., et al., Tetanus Toxin and Botulinum A andC Neurotoxins Inhibit Noradrenaline Release From Cultured Mouse Brain, JNeurochem 51 (2); 522-527:1988) CGRP, substance P and glutamate(Sanchez-Prieto, J., et al., Botulinum Toxin A Blocks GlutamateExocytosis From Guinea Pig Cerebral Cortical Synaptosomes, Eur J.Biochem 165; 675-681:1897. Thus, when adequate concentrations are used,stimulus-evoked release of most neurotransmitters is blocked bybotulinum toxin. See e.g. Pearce, L. B., Pharmacologic Characterizationof Botulinum Toxin For Basic Science and Medicine, Toxicon 35(9);1373-1412 at 1393; Bigalke H., et al., Botulinum A Neurotoxin InhibitsNon-Cholinergic Synaptic Transmission in Mouse Spinal Cord Neurons inCulture, Brain Research 360; 318-324:1985; Habermann E., Inhibition byTetanus and Botulinum A Toxin of the release of [3H]Noradrenaline and[3H]GABA From Rat Brain Homogenate, Experientia 44; 224-226:1988,Bigalke H., et al., Tetanus Toxin and Botulinum A Toxin Inhibit Releaseand Uptake of Various Transmitters, as Studied with ParticulatePreparations From Rat Brain and Spinal Cord, Naunyn-Schmiedeberg's ArchPharmacol 316; 244-251:1981, and; Jankovic J. et al., Therapy WithBotulinum Toxin, Marcel Dekker, Inc., (1994), page 5.

Botulinum toxin type A can be obtained by establishing and growingcultures of Clostridium botulinum in a fermenter and then harvesting andpurifying the fermented mixture in accordance with known procedures. Allthe botulinum toxin serotypes are initially synthesized as inactivesingle chain proteins which must be cleaved or nicked by proteases tobecome neuroactive. The bacterial strains that make botulinum toxinserotypes A and G possess endogenous proteases and serotypes A and G cantherefore be recovered from bacterial cultures in predominantly theiractive form. In contrast, botulinum toxin serotypes C1, D and E aresynthesized by nonproteolytic strains and are therefore typicallyunactivated when recovered from culture. Serotypes B and F are producedby both proteolytic and nonproteolytic strains and therefore can berecovered in either the active or inactive form. However, even theproteolytic strains that produce, for example, the botulinum toxin typeB serotype only cleave a portion of the toxin produced. The exactproportion of nicked to unnicked molecules depends on the length ofincubation and the temperature of the culture. Therefore, a certainpercentage of any preparation of, for example, the botulinum toxin typeB toxin is likely to be inactive, possibly accounting for the knownsignificantly lower potency of botulinum toxin type B as compared tobotulinum toxin type A. The presence of inactive botulinum toxinmolecules in a clinical preparation will contribute to the overallprotein load of the preparation, which has been linked to increasedantigenicity, without contributing to its clinical efficacy.Additionally, it is known that botulinum toxin type B has, uponintramuscular injection, a shorter duration of activity and is also lesspotent than botulinum toxin type A at the same dose level.

High quality crystalline botulinum toxin type A can be produced from theHall A strain of Clostridium botulinum with characteristics of ≧3×10⁷U/mg, an A₂₆₀/A₂₇₈ of less than 0.60 and a distinct pattern of bandingon gel electrophoresis. The known Shantz process can be used to obtaincrystalline botulinum toxin type A, as set forth in Shantz, E. J., etal, Properties and use of Botulinum toxin and Other MicrobialNeurotoxins in Medicine, Microbiol Rev. 56; 80-99:1992. Generally, thebotulinum toxin type A complex can be isolated and purified from ananaerobic fermentation by cultivating Clostridium botulinum type A in asuitable medium. The known process can also be used, upon separation outof the non-toxin proteins, to obtain pure botulinum toxins, such as forexample: purified botulinum toxin type A with an approximately 150 kDmolecular weight with a specific potency of 1-2×10⁸ LD50 U/mg orgreater; purified botulinum toxin type B with an approximately 156 kDmolecular weight with a specific potency of 1-2×10⁸ LD50 U/mg orgreater, and; purified botulinum toxin type F with an approximately 155kD molecular weight with a specific potency of 1-2×10⁷ LD50 U/mg orgreater.

Botulinum toxins and/or botulinum toxin complexes can be obtained fromList Biological Laboratories, Inc., Campbell, Calif.; the Centre forApplied Microbiology and Research, Porton Down, U.K.; Wako (Osaka,Japan), Metabiologics (Madison, Wis.) as well as from Sigma Chemicals ofSt Louis, Mo. Pure botulinum toxin can also be used to prepare apharmaceutical composition.

As with enzymes generally, the biological activities of the botulinumtoxins (which are intracellular peptidases) is dependant, at least inpart, upon their three dimensional conformation. Thus, botulinum toxintype A is detoxified by heat, various chemicals surface stretching andsurface drying. Additionally, it is known that dilution of the toxincomplex obtained by the known culturing, fermentation and purificationto the much, much lower toxin concentrations used for pharmaceuticalcomposition formulation results in rapid detoxification of the toxinunless a suitable stabilizing agent is present. Dilution of the toxinfrom milligram quantities to a solution containing nanograms permilliliter presents significant difficulties because of the rapid lossof specific toxicity upon such great dilution. Since the toxin may beused months or years after the toxin containing pharmaceuticalcomposition is formulated, the toxin can stabilized with a stabilizingagent such as albumin and gelatin.

A commercially available botulinum toxin containing pharmaceuticalcomposition is sold under the trademark BOTOX® (available from Allergan,Inc., of Irvine, Calif.). BOTOX® consists of a purified botulinum toxintype A complex, albumin and sodium chloride packaged in sterile,vacuum-dried form. The botulinum toxin type A is made from a culture ofthe Hall strain of Clostridium botulinum grown in a medium containingN-Z amine and yeast extract. The botulinum toxin type A complex ispurified from the culture solution by a series of acid precipitations toa crystalline complex consisting of the active high molecular weighttoxin protein and an associated hemagglutinin protein. The crystallinecomplex is re-dissolved in a solution containing saline and albumin andsterile filtered (0.2 microns) prior to vacuum-drying. The vacuum-driedproduct is stored in a freezer at or below −5° C. BOTOX® can bereconstituted with sterile, non-preserved saline prior to intramuscularinjection. Each vial of BOTOX® contains about 100 units (U) ofClostridium botulinum toxin type A purified neurotoxin complex, 0.5milligrams of human serum albumin and 0.9 milligrams of sodium chloridein a sterile, vacuum-dried form without a preservative.

To reconstitute vacuum-dried BOTOX®, sterile normal saline without apreservative; (0.9% Sodium Chloride Injection) is used by drawing up theproper amount of diluent in the appropriate size syringe. Since BOTOX®may be denatured by bubbling or similar violent agitation, the diluentis gently injected into the vial. For sterility reasons BOTOX® ispreferably administered within four hours after the vial is removed fromthe freezer and reconstituted. During these four hours, reconstitutedBOTOX® can be stored in a refrigerator at about 2° C. to about 8° C.Reconstituted, refrigerated BOTOX®) has been reported to retain itspotency for at least about two weeks. Neurology, 48:249-53:1997.

It has been reported that botulinum toxin type A has been used inclinical settings as follows:

(1) about 75-125 units of BOTOX® per intramuscular injection (multiplemuscles) to treat cervical dystonia;

(2) 5-10 units of BOTOX® per intramuscular injection to treat glabellarlines (brow furrows) (5 units injected intramuscularly into the procerusmuscle and 10 units injected intramuscularly into each corrugatorsupercilii muscle);

(3) about 30-80 units of BOTOX® to treat constipation by intrasphincterinjection of the puborectalis muscle;

(4) about 1-5 units per muscle of intramuscularly injected BOTOX® totreat blepharospasm by injecting the lateral pre-tarsal orbicularisoculi muscle of the upper lid and the lateral pre-tarsal orbicularisoculi of the lower lid.

(5) to treat strabismus, extraocular muscles have been injectedintramuscularly with between about 1-5 units of BOTOX®, the amountinjected varying based upon both the size of the muscle to be injectedand the extent of muscle paralysis desired (i.e. amount of dioptercorrection desired).

(6) to treat upper limb spasticity following stroke by intramuscularinjections of BOTOX® into five different upper limb flexor muscles, asfollows:

(a) flexor digitorum profundus: 7.5 U to 30 U

(b) flexor digitorum sublimus: 7.5 U to 30 U

(c) flexor carpi ulnaris: 10 U to 40 U

(d) flexor carpi radialis: 15 U to 60 U

(e) biceps brachii: 50 U to 200 U. Each of the five indicated muscleshas been injected at the same treatment session, so that the patientreceives from 90 U to 360 U of upper limb flexor muscle BOTOX® byintramuscular injection at each treatment session.

(7) to treat migraine, pericranial injected (injected symmetrically intoglabellar, frontalis and temporalis muscles) injection of 25 U of BOTOX®has showed significant benefit as a prophylactic treatment of migrainecompared to vehicle as measured by decreased measures of migrainefrequency, maximal severity, associated vomiting and acute medicationuse over the three month period following the 25 U injection.

It is known that botulinum toxin type A can have an efficacy for up to12 months (European J. Neurology 6 (Supp 4): S111-S1150:1999), and insome circumstances for as long as 27 months, when used to treat glands,such as in the treatment of hyperhydrosis. See e.g. Bushara K.,Botulinum toxin and rhinorrhea, Otolaryngol Head Neck Surg 1996;114(3):507, and The Laryngoscope 109:1344-1346:1999. However, the usualduration of an intramuscular injection of Botox® is typically about 3 to4 months.

The success of botulinum toxin type A to treat a variety of clinicalconditions has led to interest in other botulinum toxin serotypes. Twocommercially available botulinum type A preparations for use in humansare BOTOX® available from Allergan, Inc., of Irvine, Calif., andDysport® available from Beaufour Ipsen, Porton Down, England. ABotulinum toxin type B preparation (MyoBloc®) is available from ElanPharmaceuticals of San Francisco, Calif.

In addition to having pharmacologic actions at the peripheral location,botulinum toxins may also have inhibitory effects in the central nervoussystem. Work by Weigand et al, Nauny-Schmiedeberg's Arch. Pharmacol.1976; 292,161-165, and Habermann, Nauny-Schmiedeberg's Arch. Pharmacol.1974; 281, 47-56 showed that botulinum toxin is able to ascend to thespinal area by retrograde transport. As such, a botulinum toxin injectedat a peripheral location, for example intramuscularly, may be retrogradetransported to the spinal cord.

U.S. Pat. No. 5,989,545 discloses that a modified clostridial neurotoxinor fragment thereof, preferably a botulinum toxin, chemically conjugatedor recombinantly fused to a particular targeting moiety can be used totreat pain by administration of the agent to the spinal cord.

A botulinum toxin has also been proposed for or has been used to treatotitis media of the ear (U.S. Pat. No. 5,766,605), inner ear disorders(U.S. Pat. Nos. 6,265,379; 6,358,926), tension headache, (U.S. Pat. No.6,458,365), migraine headache pain (U.S. Pat. No. 5,714,468),post-operative pain and visceral pain (U.S. Pat. No. 6,464,986), hairgrowth and hair retention (U.S. Pat. No. 6,299,893), psoriasis anddermatitis (U.S. Pat. No. 5,670,484), injured muscles (U.S. Pat. No.6,423,319) various cancers (U.S. Pat. No. 6,139,845), smooth muscledisorders (U.S. Pat. No. 5,437,291), and neurogenic inflammation (U.S.Pat. No. 6,063,768). Controlled release toxin implants are known (seee.g. U.S. Pat. Nos. 6,306,423 and 6,312,708) as is transdermal botulinumtoxin administration (U.S. patent application Ser. No. 10/194,805).

Additionally, a botulinum toxin may have an effect to reduce inducedinflammatory pain in a rat formalin model. Aoki K., et al, Mechanisms ofthe antinociceptive effect of subcutaneous Botox: Inhibition ofperipheral and central nociceptive processing, Cephalalgia 2003September;23(7):649. Furthermore, it has been reported that botulinumtoxin nerve blockage can cause a reduction of epidermal thickness. Li Y,et al., Sensory and motor denervation influences epidermal thickness inrat foot glabrous skin, Exp Neurol 1997; 147:452-462 (see page 459).Finally, it is known to administer a botulinum toxin to the foot totreat excessive foot sweating (Katsambas A., et al., Cutaneous diseasesof the foot: Unapproved treatments, Clin Dermatol 2002November-December;20(6):689-699; Sevim, S., et al., Botulinum toxin-Atherapy for palmar and plantar hyperhidrosis, Acta Neurol Belg 2002December;102(4):167-70), spastic toes (Suputtitada, A., Local botulinumtoxin type A injections in the treatment of spastic toes, Am J Phys MedRehabil 2002 October; 81 (10):770-5), idiopathic toe walking (Tacks, L.,et al., Idiopathic toe walking: Treatment with botulinum toxin Ainjection, Dev Med Child Neurol 2002; 44(Suppl 91):6), and foot dystonia(Rogers J., et al., Injections of botulinum toxin A in foot dystonia,Neurology 1993 April; 43(4 Suppl 2)).

Tetanus toxin, as wells as derivatives (i.e. with a non-native targetingmoiety), fragments, hybrids and chimeras thereof can also havetherapeutic utility. The tetanus toxin bears many similarities to thebotulinum toxins. Thus, both the tetanus toxin and the botulinum toxinsare polypeptides made by closely related species of Clostridium(Clostridium tetani and Clostridium botulinum, respectively).Additionally, both the tetanus toxin and the botulinum toxins aredichain proteins composed of a light chain (molecular weight about 50kD) covalently bound by a single disulfide bond to a heavy chain(molecular weight about 100 kD). Hence, the molecular weight of tetanustoxin and of each of the seven botulinum toxins (non-complexed) is about150 kD. Furthermore, for both the tetanus toxin and the botulinumtoxins, the light chain bears the domain which exhibits intracellularbiological (protease) activity, while the heavy chain comprises thereceptor binding (immunogenic) and cell membrane translocationaldomains.

Further, both the tetanus toxin and the botulinum toxins exhibit a high,specific affinity for gangliocide receptors on the surface ofpresynaptic cholinergic neurons. Receptor mediated endocytosis oftetanus toxin by peripheral cholinergic neurons results in retrogradeaxonal transport, blocking of the release of inhibitoryneurotransmitters from central synapses and a spastic paralysis.Contrarily, receptor mediated endocytosis of botulinum toxin byperipheral cholinergic neurons results in little if any retrogradetransport, inhibition of acetylcholine exocytosis from the intoxicatedperipheral motor neurons and a flaccid paralysis.

Finally, the tetanus toxin and the botulinum toxins resemble each otherin both biosynthesis and molecular architecture. Thus, there is anoverall 34% identity between the protein sequences of tetanus toxin andbotulinum toxin type A, and a sequence identity as high as 62% for somefunctional domains. Binz T. et al., The Complete Sequence of BotulinumNeurotoxin Type A and Comparison with Other Clostridial Neurotoxins, JBiological Chemistry 265(16); 9153-9158:1990.

Acetylcholine

Typically only a single type of small molecule neurotransmitter isreleased by each type of neuron in the mammalian nervous system,although there is evidence which suggests that several neuromodulatorscan be released by the same neuron. The neurotransmitter acetylcholineis secreted by neurons in many areas of the brain, but specifically bythe large pyramidal cells of the motor cortex, by several differentneurons in the basal ganglia, by the motor neurons that innervate theskeletal muscles, by the preganglionic neurons of the autonomic nervoussystem (both sympathetic and parasympathetic), by the bag 1 fibers ofthe muscle spindle fiber, by the postganglionic neurons of theparasympathetic nervous system, and by some of the postganglionicneurons of the sympathetic nervous system. Essentially, only thepostganglionic sympathetic nerve fibers to the sweat glands, thepiloerector muscles and a few blood vessels are cholinergic as most ofthe postganglionic neurons of the sympathetic nervous system secret theneurotransmitter norepinephine. In most instances acetylcholine has anexcitatory effect. However, acetylcholine is known to have inhibitoryeffects at some of the peripheral parasympathetic nerve endings, such asinhibition of heart rate by the vagal nerve.

The efferent signals of the autonomic nervous system are transmitted tothe body through either the sympathetic nervous system or theparasympathetic nervous system. The preganglionic neurons of thesympathetic nervous system extend from preganglionic sympathetic neuroncell bodies located in the intermediolateral horn of the spinal cord.The preganglionic sympathetic nerve fibers, extending from the cellbody, synapse with postganglionic neurons located in either aparavertebral sympathetic ganglion or in a prevertebral ganglion. Since,the preganglionic neurons of both the sympathetic and parasympatheticnervous system are cholinergic, application of acetylcholine to theganglia will excite both sympathetic and parasympathetic postganglionicneurons.

Acetylcholine activates two types of receptors, muscarinic and nicotinicreceptors. The muscarinic receptors are found in all effector cellsstimulated by the postganglionic, neurons of the parasympathetic nervoussystem as well as in those stimulated by the postganglionic cholinergicneurons of the sympathetic nervous system. The nicotinic receptors arefound in the adrenal medulla, as well as within the autonomic ganglia,that is on the cell surface of the postganglionic neuron at the synapsebetween the preganglionic and postganglionic neurons of both thesympathetic and parasympathetic systems. Nicotinic receptors are alsofound in many nonautonomic nerve endings, for example in the membranesof skeletal muscle fibers at the neuromuscular junction.

Acetylcholine is released from cholinergic neurons when small, clear,intracellular vesicles fuse with the presynaptic neuronal cell membrane.A wide variety of non-neuronal secretory cells, such as, adrenal medulla(as well as the PC12 cell line) and pancreatic islet cells releasecatecholamines and parathyroid hormone, respectively, from largedense-core vesicles. The PC12 cell line is a clone of ratpheochromocytoma cells extensively used as a tissue culture model forstudies of sympathoadrenal development. Botulinum toxin inhibits therelease of both types of compounds from both types of cells in vitro,permeabilized (as by electroporation) or by direct injection of thetoxin into the denervated cell. Botulinum toxin is also known to blockrelease of the neurotransmitter glutamate from cortical synaptosomescell cultures.

A neuromuscular junction is formed in skeletal muscle by the proximityof axons to muscle cells. A signal transmitted through the nervoussystem results in an action potential at the terminal axon, withactivation of ion channels and resulting release of the neurotransmitteracetylcholine from intraneuronal synaptic vesicles, for example at themotor endplate of the neuromuscular junction. The acetylcholine crossesthe extracellular space to bind with acetylcholine receptor proteins onthe surface of the muscle end plate. Once sufficient binding hasoccurred, an action potential of the muscle cell causes specificmembrane ion channel changes, resulting in muscle cell contraction. Theacetylcholine is then released from the muscle cells and metabolized bycholinesterases in the extracellular space. The metabolites are recycledback into the terminal axon for reprocessing into further acetylcholine.

U.S. Pat. No. 6,585,993 discloses a controlled release neurotoxinsystem. U.S. Pat. No. 6,506,399 discloses a biodegradable botulinumtoxin implant. U.S. Pat. No. 6,383,509 discloses a biodegradableneurotoxin implant. U.S. Pat. No. 6,312,708 discloses a botulinum toxinimplant. U.S. Pat. No. 6,306,423 discloses a neurotoxin implant

Thus, there remains a need for new compositions and methods which may beused to treat skin conditions and enhance cosmetic features ofindividuals.

SUMMARY

The present invention addresses this need and provides new cosmeticcompositions and methods that provide long lasting effective treatmentof cosmetic defects.

In a broad embodiment, a composition useful for treating a cosmeticdefect in an individual comprises a botulinum toxin component; and amicrosphere component comprising a plurality of swellable microspheres.The botulinum toxin component can comprise one or more botulinum toxins,such as botulinum toxin type A, B, C, D, E, F, or G. The microspherecomponent can be understood to be a hydrogel material, and may comprisea plurality of particles of crosslinked polymers. The botulinum toxincan be mixed with, coupled to, or encapsulated by the particles.

In one embodiment, a composition useful for treating a cosmetic defectin an individual comprises a cosmetic defect treating amount ofbotulinum toxin type A; and a plurality of swellable microsphereseffective in treating a cosmetic defect of the individual.

The present compositions provide enhanced treatment of cosmetic defectsrelative to substantially identical compositions without a botulinumtoxin component.

The present invention also encompasses a method of treating a cosmeticdefect or deficiency by administering a cosmetic composition, such asthe foregoing compositions, to an individual in need of treatment, suchas a person who desires such cosmetic treatment.

Each and every feature described herein, and each and every combinationof two or more of such features, is included within the scope of thepresent invention provided that the features included in such acombination are not mutually inconsistent. In addition, any feature orcombination of features may be specifically excluded from any embodimentof the present invention.

Additional aspects and advantages of the present invention are set forthin the following description and claims, particularly when considered inconjunction with the accompanying drawings.

Definitions

The following definitions apply herein.

“About” means plus or minus ten percent of the value so qualified.

“Biocompatible” means that there is no significant inflammatory orantigenic response from administration of the composition.

“Biologically active compound” means a compound which can effect abeneficial change in the subject to which it is administered. Forexample, “biologically active compounds” include neurotoxins.

“Effective amount” as applied to the biologically active compound meansthat amount of the compound which is generally sufficient to effect adesired change in the subject. For example, where the desired effect isa reduction in a wrinkle, an effective amount of the compound is thatamount which causes at least a substantial reduction of the wrinkle, andwithout resulting in significant toxicity.

“Effective amount” as applied to a non-active ingredient constituent ofan injectable composition (such as a carrier used for mixing with abotulinum toxin) refers to that amount of the non-active ingredientconstituent which is sufficient to positively influence the releaseand/or activity of the active ingredient when administered to anindividual. This “effective amount” can be determined based on theteaching in this specification and the general knowledge in the art.

“Neurotoxin” means an agent which can interrupt nerve impulsetransmission across a neuromuscular or neuroglandular junction, block orreduce neuronal exocytosis of a neurotransmitter or alter the actionpotential at a sodium channel voltage gate of a neuron. Examples ofneurotoxins include botulinum toxins, tetanus toxins, saxitoxins, andtetrodotoxin.

“Treatment” means any treatment of a disease in a mammal, and includes:(i) preventing the disease from occurring or; (ii) inhibiting thedisease, i.e., arresting its development; (iii) relieving the disease,i.e., reducing the incidence of symptoms of or causing regression of thedisease. Cosmetic treatment refers to reducing or treating one or morecosmetic defects or deficiencies.

“Microspheres” refers to a polymer or combinations of polymers made intobodies or elements of various sizes. The microspheres can be in anyshape, although they are often in substantially spherical shape.

“Swellable” microspheres, as used herein, refers to microspheres thatare capable of being enlarged in size, yet still retain substantiallythe same shape, upon certain conditions such as contacting physiologicalfluids or other aqueous fluids. Preferably, the swellable microspheresof the present invention can be enlarged to about 4 times of theiroriginal diameter or 15 times of their original volume. The degree ofswelling can be controlled by controlling factors such as the solventsin which they are suspended, specific polymers used to make themicrospheres and degree of crosslinking. This property enables themicrospheres be easily injected through needles of 30 gauge or smaller,yet be enlarged and secured at the injection site and of sufficient sizeto avoid or reduce the chance of being eliminated by the immune systemof the individual.

“High water absorbing polymers” as used in the present invention refersto polymers that can absorb at least 5% water by weight or that arecapable of increasing the dry weight of the polymers to about 20 timesof their original dry weight. The microspheres of the presentcompositions also comprise particles that are “hydrophilic,” which, asused in the invention, means the particles can dissolve in, absorb, ormix easily with water or aqueous solution.

“Biodegradable” microspheres refer to microspheres that are capable ofbeing absorbed by the body, chemically, physiologically, or by otherbiological means, over a period of time.

“Substantially spherical” generally means a shape that is close to aperfect sphere, which is defined as a volume that presents the lowestexternal surface area. Specifically, “substantially spherical” in thepresent invention means, when viewing any cross-section of the particle,the difference between the average major diameter and the average minordiameter is less than 20%. The surfaces of the microspheres of thepresent invention appear smooth under magnification of up to 1000 times.The microspheres of the present invention may comprise, in addition tothe particles, other materials as described and defined herein.

“Dermal augmentation” in the context of the present disclosure refers toany change of the natural state of an individual's skin and relatedareas due to external acts. The areas that may be changed by dermalaugmentation include, but not limited to, epidermis, dermis,subcutaneous layer, fat, arrector pill muscle, hair shaft, sweat pore,sebaceous gland, and subdermal musculature. Dermal augmentation is usedto treat cosmetic defects and/or cosmetic deficiencies.

“Cell adhesion promoter” as used herein refers to any material that,because of its presence in or association with the microspheres,promotes or enhances the adhesiveness of cells to the surface of themicrospheres. These materials are often proteins that are bound to thesurface of the microspheres through covalent bonds of the proteins andthe polymers.

“Therapeutic agent” as used herein refers to any substance that providestherapeutic effects to the process of dermal augmentation or biologicalor physiological responses to the dermal augmentation. An example oftherapeutic agent is a neurotoxin which is effective in relaxingmuscles. One example of a suitable neurotoxin is a neurotoxin producedby Clostridial bacteria, such as Clostridium beratti, Clostridiumbutyricum, Clostridium tetani, and Clostridium botulinum. As describedherein, preferred compositions comprise a botulinum toxin component. Abotulinum toxin component is a portion of the composition which includesone or more botulinum toxin types selected from the group consisting ofbotulinum toxin types A, B, C, D, E, F, and G. The botulinum toxincomponent may comprise a botulinum toxin produced by a Clostridialbacteria, or produced by recombinant technology. The botulinum toxin canbe a recombinantly made or a hybrid botulinum toxin. In preferredcompositions, the botulinum toxin component comprises a botulinum toxintype A, such as the commercially available botulinum toxin sold underthe tradename, BOTOX® (Allergan, Inc., CA).

“Chemical modification” in the present invention means the changes ofchemical properties and characteristics of the microspheres, eitherduring their production process or by way of mixing or contacting themwith various agents or tissues, such that the microspheres have theability to perform, in addition to dermal augmentation, other functionsonce injected into the body.

DESCRIPTION

Compositions and methods have been invented which provide effective,long lasting treatment of skin or dermal conditions. The presentcompositions comprise swellable microspheres and one or more Clostridialneurotoxins. The present cosmetic compositions and methods may beeffective in augmenting the skin of an individual, such as a person, toenhance cosmetic features of the individual. Thus, the present inventionrelates to cosmetic treatment of a dermal condition, such as wrinkles,other skin contour deficiencies, and the like. Or stated differently,the present invention relates to compositions and methods for treatingone or more cosmetic defects of deficiencies.

In one embodiment of the present invention, a composition comprises abotulinum toxin component, and a microsphere component. The compositionmay be administered, such as by injection, to provide a cosmetic ortherapeutic benefit to an individual. Accordingly, the composition maybe useful for dermal augmentation. The microsphere component of thecomposition comprises a plurality of swellable microspheres. Forexample, the composition comprises a plurality of microspheres thatswell when in contact with an aqueous fluid, such as a physiologicalfluid. The composition is preferably sterile when administered to anindividual. In addition, prior to administration, the composition may beprovided in a lyophilized state, or may include a non-aqueous solventcomponent. Thus, the present compositions may be understood to comprisea botulinum toxin component, such as one or more botulinum toxins, and ahydrogel material, such as a water-swellable material. The hydrogelmaterial may be the microspheres disclosed herein.

The botulinum toxin component may be associated with the microspherecomponent so that the composition is effective in enhancing oraugmenting a cosmetic feature, such as a defect, of the individual.Without wishing to be bound by theory, a physiological mechanism can beproposed for the efficacy of my invention as disclosed herein for thetreatment of a cosmetic defect or deficiency using a Clostridialneurotoxin. Essentially, it is hypothesized that use of a Clostridialneurotoxin, such as botulinum toxin, can inhibit release ofacetylcholine from one or more nerves innervating a muscle associatedwith the cosmetic defect or deficiency to relax the muscle, and themicrospheres of the composition can increase in size when subdermally orintradermally administered to augment the skin and reduce the cosmeticdefect or deficiency, thereby treating the cosmetic defect ordeficiency. Thus, the augmenting of the skin of an individual may beachieved by the combination of the swelling of the microspheres, and bythe enzymatic activity of a botulinum toxin of the botulinum toxincomponent. As indicated herein, the botulinum toxin component of thepresent compositions may comprise a botulinum toxin selected from thegroup consisting of botulinum toxin types A, B, C, D, E, F, G, andmixtures thereof. In certain preferred compositions, the botulinum toxincomponent comprises only a botulinum toxin type A. Botulinum toxin typeA is desirable due to its high potency in humans, ready availability,and known use for the treatment of skeletal and smooth muscle disorderswhen locally administered by intramuscular injection.

Although the present compositions are described with particularreference to botulinum toxins, other neurotoxins may be effective in thepresent compositions with or without the botulinum toxins, and suchother neurotoxins are included within the scope of the presentinvention. Examples of other Clostridial neurotoxins within the scope ofthe present invention include neurotoxins made by Clostridium butyricumand Clostridium beratti species. The present invention also includes theuse of (a) Clostridial neurotoxins obtained or processed by bacterialculturing, toxin extraction, concentration, preservation, freeze drying,and/or reconstitution; and/or (b) modified or recombinant neurotoxins,that is neurotoxins that have had one or more amino acids or amino acidsequences deliberately deleted, modified or replaced by knownchemical/biochemical amino acid modification procedures or by use ofknown host cell/recombinant vector recombinant technologies, as well asderivatives or fragments of neurotoxins so made. These neurotoxinvariants retain the ability to inhibit neurotransmission between oramong neurons, and some of these variants may provide increaseddurations of inhibitory effects as compared to native neurotoxins, ormay provide enhanced binding specificity to the neurons exposed to theneurotoxins. These neurotoxin variants may be selected by screening thevariants using conventional assays to identify neurotoxins that have thedesired physiological effects of inhibiting neurotransmission.

Botulinum toxins for use according to the present invention can bestored in lyophilized, vacuum dried form in containers under vacuumpressure or as stable liquids. Prior to lyophilization the botulinumtoxin can be combined with pharmaceutically acceptable excipients,stabilizers and/or carriers, such as albumin. The lyophilized materialcan be reconstituted with saline or water to create a solution orcomposition containing the botulinum toxin to be administered to thepatient.

The neurotoxin may be combined with the microsphere component and storedfor prolonged periods of time prior to administration to an individual,or may be combined with the micropshere component in an injectablecomposition, for example, immediately prior to administration to anindividual. Care should be taken to reducing the amount of liquid, suchas an aqueous liquid, in the compositions comprising a microspherecomponent since the microsphere component has a plurality of swellablemicrospheres.

The amount of the Clostridial toxin in the compositions or administeredaccording to the present methods can vary according to the particularcharacteristics of the skin disorder being treated, including itsseverity and other various patient variables including size, weight,age, and responsiveness to therapy. To guide the practitioner,typically, no less than about 1 unit and no more than about 50 units ofa botulinum toxin type A (such as BOTOX®) is administered per injectionsite (i.e. to each skin location injected), per patient treatmentsession. For a botulinum toxin type A such as DYSPORT®, no less thanabout 2 units and no more about 200 units of the botulinum toxin type Aare administered per administration or injection site, per patienttreatment session. For a botulinum toxin type B such as MYOBLOC®, noless than about 40 units and no more about 2500 units of the botulinumtoxin type B are administered per injection site, per patient treatmentsession. Less than about 1, 2 or 40 units (of BOTOX®, DYSPORT® andMYOBLOC® respectively) can fail to achieve a desired therapeutic effect,while more than about 50, 200 or 2500 units (of BOTOX®, DYSPORT® andMYOBLOC® respectively) can result in clinically observable and undesiredmuscle hypotonicity, weakness and/or paralysis.

More preferably: for BOTOX® no less than about 2 units and no more about20 units of a botulinum toxin type A; for DYSPORT® no less than about 4units and no more than about 100 units, and; for MYOBLOC®, no less thanabout 80 units and no more than about 1000 units are, respectively,administered per injection site, per patient treatment session.

Most preferably: for BOTOX® no less than about 5 units and no more about15 units of a botulinum toxin type A; for DYSPORT® no less than about 20units and no more than about 75 units, and; for MYOBLOC®, no less thanabout 200 units and no more than about 750 units are, respectively,administered per injection site, per patient treatment session. It isimportant to note that there can be multiple injection sites (i.e. apattern of injections) for each patient treatment session.

Thus, the botulinum toxin component of the present compositions maycomprise an amount of botulinum toxin in a range from about 1 unit toabout 50,000 units. The amount of botulinum toxin component present inthe composition will vary depending on the type of botulinum toxinprovided, such as the serotype or strain of botulinum toxin, and theamount of the composition to be administered to a patient. In certaincompositions, the botulinum toxin comprises an amount of 10 units toabout 2,000 units of a botulinum toxin type A. In other compositions,the botulinum toxin component comprises an amount of botulinum toxin ina range from about 100 units to about 30,000 units of a botulinum toxintype B. Preferably, the present compositions only comprise biologicallyactive botulinum toxins as a therapeutic agent. For example, the presentcompositions are substantially free of a botulinum toxoid.

The present cosmetic compositions also comprise swellable microspheres.The microspheres of the present compositions are also preferablyhydrophilic, non-toxic, and, substantially spherical. The microspheresare at least a portion, including an entire portion, of a microspherecomponent. The microsphere component thus has an average microspherediameter (e.g., the average diameter of a population of microspherespresent in the composition). In certain embodiments of the presentcompositions, the average microsphere diameter after administration ofthe composition to an individual is between about one to about fourtimes greater than the average microsphere diameter beforeadministration. The increase in average microsphere diameter is due tothe swellability of the microspheres. For example, as the composition isadministered to an individual, the microspheres contact a fluid, such asan aqueous body fluid. The microspheres incorporate the fluid and swellas a result.

The microspheres of the present compositions may comprise a plurality ofcrosslinked polymers. Such polymers may be crosslinked usingconventional methods routinely known to persons of ordinary skill in theart. The polymers of the microspheres may be hydrophilic. Thus, asdescribed herein, the microsphere component of the present compositionsmay be a hydrogel material. The microspheres swell when the contact anaqueous fluid. As understood by a person skilled in the art, the degreeof swelling of crosslinked polymers generally depends on the propertiesof the polymeric materials such as their ionic character, thehydrophilicity of the polymeric materials, and the degree ofcrosslinking. Properties, such as salt and ionic concentration and levelof pH, of the solvent in which the microspheres are suspended or withwhich the microspheres are contacting also affect the degree ofswelling.

By controlling the size and the degree of swelling of certaincrosslinked and swellable polymers, safe, effective, and long lastingdermal augmentation can be achieved using these microspheres. Generally,polymeric materials having high water absorbing ability are firstchosen. The swellability of these polymers can be further manipulated bycontrolling the polymer's ionic character and the degree of crosslinkingby methods known to a skilled person.

The microspheres of the present invention can be either anionic orcationic. Cationic microspheres may be desirable due to their superiorability of promoting cell adhesion. The crosslinking degree of themicrospheres can be changed either chemically or through radiation. Avariety of crosslinking agents may be used, including, but not limitedto, tetraethylene glycol diacrylate, tetraethylene glycoldimethacrylate, ethylene glycol dimethacrylate, methacrylate, andpentaerythritol dimethacrylate. The microspheres of the invention maycomprise from about 0.5% to about 20%, by molecular weight, ofcrosslinkers. For example, the microspheres may comprise from about 1%to about 5%, by molecular weight, of crosslinkers.

The swelling of the microspheres comprising these polymers can befurther controlled by controlling the solvent in which the microspheresare suspended. This can be achieved through two steps as disclosedherein. First, the size of the microspheres before injection arecontrolled by using appropriate solvents, salt concentration and pHlevel according to the specific microspheres used. The microspheresbefore injection may either remain in their original size or swell tocertain degree due to their contact with the solvent. The pre-injectionswelling is controlled so that the microspheres are easily injectablethrough 30 gauge or smaller needles. Second, after injection and uponcontacting with tissues at injection site, the microspheres may furtherswell into predetermined size or retain their pre-injection size, eitherof which size will allow the microspheres to be secured at the site ofinjection and achieve desired dermal augmentation effect. The degree ofpre-injection swelling, and thus the post-injection swelling, isdetermined by the particular microspheres used and the nature andlocation of the skin deficiencies being treated.

Microspheres for use in the present compositions may have diametersrange from about 10 μm to about 400 μm before swelling. For example,before swelling, the diameters of the microspheres may range from about10 μm to about 200 μm, such as, from about 10 μm to about 120 μm. Afterinjection and swelling, the microspheres generally have averagediameters larger than 40 μm, for example larger than about 50 μm, suchas larger than about 70 μm. The microspheres of the present compositionsare capable of swelling to about four times their original diameters orabout fifteen times their original volume. The full swollen size of themicrospheres after administration may be controlled, by various meansdiscussed herein, so that the microspheres are secured at the site ofinjection while minimizing or reducing potential injuries to thetissues. Further, the full swollen sizes of the microspheres afterinjection are predetermined based on factors such as the physiologicalconditions of the injection site, the original microspheres sizes, thesolvent used and the pre-injection swelling of the microspheres. Thus, aspecific injection plan can be designed according to the particulardermal augmentation need of the case. These sizes and properties of themicrospheres are advantageous in that they enable the microspheres to beeasily injectable through needles of 30 gauge or smaller, yet themicrospheres are large enough so that they will be secured at the siteof injection and will not be digested or eliminated by macrophage orother elements of the immune system.

The microspheres also appear to be resistant to injection force createdby 30 gauge or smaller needles and to the muscle contraction stressgenerated during and after the injection process. The microspheres arealso thermally stable which allows for easy, convenient sterilization,and frozen storage for the preparation of injection.

Many types of crosslinked polymers having high water absorbing abilityare suitable for use in the present compositions. Such crosslinkedpolymers are preferably non-toxic to tissues and cells and arebiocompatible. Preferably, the polymers are selected from the groupconsisting of sodium acrylate polymer, acrylamide polymers, acrylamidederivative polymers or copolymers, sodium acrylate and vinyl alcoholcopolymer, saponification products of copolymer of vinyl acetate andacrylic acid ester, vinyl acetate and acrylic acid ester copolymer,vinyl acetate and methyl maleate copolymer, isobutylene-maleic anhydridecrosslinked copolymer, starch-acrylonitrile graft copolymer and itssaponification products, crosslinked sodium polyacrylate polymer, andcrosslinked polyethylene oxide.

The microspheres of the present invention can be biodegradable ornonbiodegradable. Further, the microspheres of the present invention arethermally stable which allows for easy, convenient sterilization, andfrozen storage. The microspheres for use in the present invention arealso stable in suspension which allows the microparticles to beformulated and stored in suspension and injected with different liquidsor oils. More specifically, the hydrophilic nature of the microspherespermits placing them in suspension, and in particular, in sterile formof injectable solutions, while avoiding the formation of aggregates oradhesion to the walls of storage containers and implantation devices,such as catheters, syringes, needles, and the like.

The microspheres of the present invention may contain within theirstructure or on their surfaces other chemicals or agents, thereforedisplaying particular properties, such as therapeutic, radio-pacifying,and contrasting effects; targeting promotion of cell adhesion; andcapability of being chemically modified. Thus, the microspheres maycomprise an agent selected from the group consisting of radio-pacifyingagents, contrast agents, targeting agents, and mixtures thereof. In oneembodiment of the present compositions, the microspheres comprise a celladhesion promoter. In another embodiment, the microspheres may comprisecells provided on the surface or surfaces of the microspheres. The cellsmay be autologous cells.

The microspheres of the present invention may further associated withcontrast medium or agent. Contrast media useful within the presentinvention can be found in Dawson et al. Contrast Medium in Practice(Springer-Verlag, 1994). Contrast media include, and are not limited to,ultrasonic media, superparamagnetic media, and gadolinium contrastmedia. Preferably, the contrast media include any media that containbarium or iodine salts, such as high molecular weight salts, includingacylamino-e-propion-amido-3-triiodo-2, 4, 6-benzoic acid, which can beprepared under the conditions described by Boschetti et al. (Bull. Soc.Chim., No. 4 France, (1986)). In the case of barium or magnetite salts,they can be directly introduced in powdered form in the initial monomersolution.

In another embodiment of the invention, the microspheres have specificproperties suitable for cell adhesion and cells growth promotion, makingthe microspheres particularly useful for certain dermal augmentation.Cells can be associated with the microspheres, through adhesion or othermeans, prior to injection. The cells may be autologous cells obtainedfrom or derived from the individual receiving the cosmetic composition.These autologous cells are preferably the same type of cells that needto be repaired in the dermal augmentation, such as fat cells, musclecells, subcutaneous cells, dermal cells, epidermal cells, or mixturesthereof. The autologous cells may also preferably be cells that enhanceor promote the growth or connection of cells or tissues, such asfibroblast cells.

Various types of cell adhesion promoters or agents well known in the artmay be used in the micropsheres of the present compositions. Forexample, cell adhesion agents can be selected from collagen, gelatin,glucosaminoglycans, fibronectins, lectins, polycations (such polylysine,chitosan and the like), extracellular matrix, degradation products ofcells or tissues, or any other natural or synthetic biological celladhesion agent.

Cell adhesion promoters or marking agents can be introduced onmicrospheres by chemical coupling procedures well known in affinitychromatography, referred to by the term “ligand immobilization”. Anothermethod of introduction is by diffusion within the gel network thatconstitutes the bead and then trapping the diffused molecules in placeby precipitation or chemical cross-linking.

The neurotoxin, such as the botulinum toxin, of the present compositionsis associated with the microsphere component to provide effectivetreatment of a dermal condition. The neurotoxin can be mixed with themicrospheres so that the neurotoxin and microspheres are physicallydistinct, but cooperatively interact to provide the desired cosmeticbenefits disclosed herein. Or, the neurotoxin may be coupled with themicrospheres. For example, the microspheres can be chemically modifiedso that they will be physically coupled to the neurotoxin. For example,the neurotoxin may be covalently coupled to the microspheres.Alternatively, the neurotoxin can be incorporated into a polymericnetwork of the microspheres so that the neurotoxin is not releasiblefrom the microspheres until the microspheres swell. Or, the neurotoxinmay be complexed with the microspheres as a result of ionic interactionsthat are not covalent bonds.

Incorporation of the neurotoxins into the microspheres of the presentcompositions can be accomplished using any routine method known topersons of ordinary skill in the art. For example, the incorporation canbe accomplished by mixing dry microspheres with solutions of theneurotoxin in an aqueous or hydro-organic solution. The microspheresswell by adsorbing the solutions and incorporate the neurotoxin into themicroparticle network. The neurotoxin may remain inside the microspheredue to an active mechanism of adsorption essentially based on ionexchange effect.

Microspheres of the present invention may further possess the propertyof non-aggregating, which usually results from an ionic charge of themicrospheres. This property facilitates injection and more effectivedermal augmentation, especially in situations where cells are associatedwith the microspheres. This property is important to dermal augmentationof the present invention because it makes injection of the microspheresthrough 30 gauge or smaller needles possible and easier. This propertyof the microspheres also prevents them from aggregating or adhering tosyringe or needle walls or other device used in the process.

The microspheres of the present compositions can be obtained by standardmethods of polymerization described in the art such as French Patent2,378,808 and U.S. Pat. Nos. 5,648,100 and 5,635,215. In general, thepolymerization of monomers in solution is carried out at a temperatureranging between about 0° C. and about 100° C., for example between about40° C. and about 60° C., in the presence of a polymerization reactioninitiator.

Microspheres can also be prepared by suspension polymerization,drop-by-drop polymerization or any other method known to a person ofordinary skill in the art. The mode of microsphere preparation selectedwill usually depend upon the desired characteristics, such asmicrosphere diameter and chemical composition, for the resultingmicrospheres. The microspheres can also be made by methods ofpolymerization described in the art (see, e.g., E. Boschetti,Microspheres for Biochromatography and Biomedical Applications. Part I,Preparation of Microbeads In: Microspheres, Microencapsulation andLiposomes, John Wiley & Sons, Arshady R., Ed., 2:171-189 (1999)).Microspheres can also be prepared starting from an aqueous solution ofmonomers containing adhesion agents such as collagen (gelatin is adenatured collagen). The solution is then mixed with anon-aqueous-compatible solvent to create a suspension of droplets, whichare then turned into solid gel by polymerization of monomers by means ofappropriate catalysts. Microspheres are then collected by filtration orcentrifugation and washed.

The present compositions may comprise a carrier component. The carriercomponent of certain useful compositions may be an aqueous composition,and in certain embodiments, the carrier component is saline. However,many types of emulsions and solvents can be used as a biocompatiblecarrier for the present compositions. The solvent may be in such acondition that the microspheres can be uniformly suspended and, moreimportantly, that the swelling of the microspheres can also becontrolled by adjusting the solvent, the salt and ionic concentration,the pH value, or combinations thereof. Some additional suitable solventsfor the present compositions include aqueous based solutions such as PBSsolutions, alcohol based solutions, and other biocompatiblehydro-organic solutions known in the art.

Salt concentration and pH level of the solvent are useful to control thedegree of swelling of the microspheres once they are suspended in thesolvent. The presence of cations such as sodium, potassium, calcium,magnesium, iron, zinc, and ammonium has various level of effects on thedegree of swelling of the microspheres depending on the specific polymerand salt used. The degree of swelling of the microspheres is partiallycontrollable by changing the balance of smaller cations and largercations between the solvent and the microspheres. A salt level of 0.01 Mto 5 M is effective to keep the microspheres from swelling. While themicrospheres swell uninhibitedly under a neutral pH level, the change ofpH level may affect the degree of swelling. For the anionicmicrospheres, the preferred pH level to shrink the microspheres or tokeep them from swelling is from about 0.5 to 5. For the cationicmicrospheres, a pH level ranges from about 6 to about 11 will shrink themicrospheres or keep them from swelling. Thus, acidic pH's may providebeneficial effects when the composition comprises both anionicmicrospheres and botulinum neurotoxin.

Upon suspension in the solvent and before injection, the microspheresmay swell and the degree of swelling is controlled by the solvent andother conditions, such as time and temperature of suspension. Thepre-injection swelling of the microspheres is further determined by thedesired after-injection-swelling for the microspheres. Thus,microspheres that have obtained high degree of swelling before injectionwill swell little after injection, whereas microspheres that haveswelled little before injection will obtain a higher degree of swellingafter injection. The size of the microspheres before, during and afterinjection is generally controlled such that they are easily injectablethrough 30 gauge or smaller needles yet become secured at the site ofinjection.

The biocompatible carrier of the present invention can also be anemulsion. In this embodiment, the properties of the microspheres,especially their size and degree of swelling, are preserved through thewell controlled balance between the aqueous and the non-aqueous phasesin the emulsion.

The present compositions may comprise a botulinum toxin componentassociated with a microsphere component so that the composition iseffective in augmenting a cosmetic feature of an individual for a periodof time ranging from about one month to about six years afteradministration to the individual. Advantageously, the presentcompositions provide enhanced cosmetic effects relative to substantiallyidentical compositions without a neurotoxin, such as a botulinum toxin.For example, the present compositions may provide a cosmetic enhancementor augmentation due to the paralytic effects of the neurotoxin, and theswellable nature of the microspheres. In addition, the botulinum toxincomponent may be associated with the microsphere component so that thebotulinum toxin retains a enzymatic activity after passing through aneedle of about 30 gauge or smaller.

Thus, the present injectable composition comprise microspheres in anamount from about 10% to about 90% by weight and the biocompatiblecarrier in an amount from about 10% to about 90% by weight. For example,the amount ranges from 10% to 50% by weight for microspheres and from50% to 90% for biocompatible carrier. The relative amount of themicrospheres and the carrier changes according to the need of thespecific dermal augmentation performed, depending on factors such assize of needle used, type of microspheres and carriers used, type ofskin deficiency, area of injection, type of tissue or cells beingaugmented, and whether cells are associated with the microspheres priorto injection.

To prepare a suspension of the microspheres, dried sterilizedmicrospheres can be mixed with a desired solvent at a pre-determinedtime such that the pre-injection swelling of the microspheres iscontrolled. The solvent can be pre-sterilized or the suspension ofmicrospheres and the solvent can be sterilized together before injectionthereof. Factors such as the material, size and crosslinking degree ofthe microspheres; the type, volume, salt concentration, pH level andtemperature of the solvent; and the time of mixing are all consideredbefore an injectable suspension is made and the injection is carried outthereafter.

The composition of the present invention is easily injectable, throughneedles of 30 gauge or smaller, into all parts of an individual, such asa human patient, who desires treatment of a cosmetic defect ordeficiency. The composition can be administered, such as by injection,without causing significant pain or discomfort.

This is due to, among other factors, the size and the physicalresiliency of the microspheres, the biocompatible nature of the carrier,and the amount of the composition administered in accordance with thecharacter and location of the skin deficiency.

In another embodiment of the present invention, a composition useful fordermal augmentation in an individual comprises a dermal augmentingamount of a botulinum toxin type A, and a plurality of swellablemicrospheres effective in augmenting a dermal condition of theindividual. Such a composition may be an injectable compositioneffective in treating wrinkles. For example, such a composition may beeffective in providing long-lasting treatment of marrionette lines,glabellar lines, crows feet, brow furrows, or combinations thereof. Thebotulinum toxin type A is typically provided in an amount effective inproviding a longer lasting anti-wrinkle effect relative to asubstantially identical composition without a botulinum toxin. Incertain compositions, the composition also comprises at least oneadditional botulinum toxin, such as a botulinum toxin type B, C, D, E,F, or G. As discussed herein, the plurality of microspheres of thecomposition has an average microsphere diameter, and in certaincompositions, the average microsphere diameter increases after injectioninto the individual from about one time to about four times the averagemicrosphere diameter prior to injection.

Although examples of routes of administration and dosages are provided,the appropriate route of administration and dosage are generallydetermined on a case by case basis by the attending physician. Suchdeterminations are routine to one of ordinary skill in the art (see forexample, Harrison's Principles of Internal Medicine (1998), edited byAnthony Fauci et al., 14th edition, published by McGraw Hill). Forexample, the route and dosage for administration of a Clostridialneurotoxin according to the present disclosed invention can be selectedbased upon criteria such as the solubility characteristics of theneurotoxin chosen as well as the intensity and scope of the cosmeticcondition being treated.

In another embodiment of the present invention, a method for treating adermal condition, such as a wrinkle or other skin deficiency, comprisesadministering the composition disclosed herein to an individual in needof treatment, or who desires such treatment for the dermal condition. Asdiscussed herein, the present compositions are effective in treatingdermal conditions including marrionette lines, glabellar lines, crowsfeet, brow furrows, and the like, and combinations thereof. Thecompositions can be injected into the individual using a needle or aneedleless device. In certain embodiments, the method comprisessubdermally injecting the composition in the individual. For example,the administering may comprise injecting the composition through aneedle no greater than about 30 gauge. In certain embodiments, themethod comprises administering a composition comprising a botulinumtoxin type A. The present methods may be effective in treating a dermalcondition for a longer time relative to administering a substantiallyidentical composition without a botulinum toxin.

In a further embodiment, the method may include an additional step ofadministering a botulinum toxin to the individual. Thus, the individualmay receive be administered a composition comprising a botulinum toxinand a plurality of swellable microspheres, and a different compositiononly comprising a botulinum toxin as a therapeutic or cosmetic agent.

Injection of the compositions can be carried out by syringe, catheters,needles and other means for injecting or infusing microspheres in aliquid medium. The injection can be performed on any area of themammal's body that is in need of treatment, including, but not limitedto, face, neck, torso, arms, hands, legs, and feet. The injection can beinto any position in the specific area such as epidermis, dermis, fat,or subcutaneous layer. A particular effective position of injectionaccording the present invention's methods, is the subcutaneous layer,which allows the microspheres and the associated agents and cellsperform more effectively.

The frequency and the amount of injection under the present invention isdetermined based on the nature and location of the particular skindeficiency being treated. Generally, because of the stable and longlasting character of the present invention's injectable composition,multiple injections are not necessary. In certain cases, however,repeated injection may be desired to achieve optimal results. Thefrequency and the amount of the injection for each particular case isdetermined by the person of ordinary skill in the art.

As disclosed herein, after injection, the microspheres become secured atthe position of the injection. The microspheres are not significantlydigested or eliminated by macrophage or other elements of the immunesystem. Furthermore, the microspheres will not displace or slide awayfrom the position of injection. The secure positioning of themicrospheres near the injection site is due to, among other factors,their size, physical resiliency, and hydrophilicity. The swellability ofthe microspheres at the site of injection is important in helping securethe microspheres at the site of injection. Upon contacting thephysiological fluids and the cells at the site of injection, themicrospheres may further swell if there is no pre-injection swelling orthe swelling is controlled to a lower level. The physiologicalcondition, including salt concentration (e.g., sodium and potassium) andpH level, may further help the microspheres swell to the desired size.

This property of the microspheres allows precise control of theinjection and makes it possible that the microspheres work together atposition of injection and provide a scaffold for effective dermalaugmentation. Because of the precision of the injection and the securingof the microspheres at the site of injection provided by the invention,it is now possible to create a scaffold of microspheres at the site ofinjection without forming a scaffold of the microspheres beforeinjection. The “injectable scaffold” comprising a Clostridial neurotoxincomponent is especially advantageous over prior art in which surgicalprocedures are necessary in order to implant a scaffold for certaindermal augmentation, or require separate administration of a botulinumtoxin composition. This discovery significantly reduces the complexityof dermal augmentation when a scaffold is desired for more effectivedermal augmentation in certain cases. This unique contribution of thepresent invention to dermal augmentation and the treatment of skindeficiencies is made possible, in part, by the well controlled size anddegree of swelling of the microspheres, as well as the neurotoxiceffects of the neurotoxin, as discussed above. The ability of forming ascaffold at the injection site without forming a scaffold before theinjection makes the microspheres and neurotoxin of the present inventionparticularly effective in providing dermal augmentation. The size of thescaffold is determined by the amount and frequency of the injection,which is in turn determined by the nature and location of the skindeficiency being treated.

The present methods are particularly suitable for treatment of skincontour deficiencies, which are usually results of aging, environmentalexposure, weight loss, child bearing, injury, surgery, or combinationsthereof. Aging and environmental exposure often cause wrinkles onvarious positions of the skin. Weight loss and child bearing, on theother hand, often cause stretch marks on various positions of the skin,especially on stomach, areas of the lower body, and legs. Injury andsurgery often result in scars in areas of injury and operation. Specificcontour deficiencies suitable for treatment by the present invention'smethod include, but not limited to, frown lines, worry lines, wrinkles,crow's feet, marionette lines, stretch marks, and internal and externalscars including scars resulted from injury, wounds, accidents, bites,surgery. The present methods advantageously provide dermal augmentationtreatment for these various contour deficiencies in an effective, longerlasting, and stable manner than previous compositions. Particularlysuitable for treatment according to the present invention are contourdeficiencies of such areas as eyes, cheeks, nose, lips, forehead, andneck.

The present invention also provides method for treating skindeficiencies, especially deficiencies caused by diseases such as acneand cancer. These deficiencies can be direct or indirect results of thediseases, such as deficiencies caused by the treatment of the diseases.

The present invention further provides method of causing dermalaugmentation by injecting the injectable composition not directly intothe body, but extracorporeally into organs, components of organs, ortissues prior to the inclusion of said tissues, organs or components oforgans into the body.

A kit for performing dermal augmentation is also encompassed by thepresent disclosure. The kit comprises a 30 gauge or smaller needle and acorresponding syringe, wherein the syringe optionally contains acomposition comprising biocompatible, swellable, hydrophilic, non-toxicand substantially spherical microspheres and a biocompatible carrier.The kit also comprises a Clostridial neurotoxin composition, such as abotulinum toxin composition. The neurotoxin composition may be providedin the syringe with the microspheres, but preferably, the neurotoxincomposition is mixed with the microsphere composition immediately priorto administration to the individual. The composition is injectablethrough the needle and the microspheres are not capable of beingdigested or eliminated by macrophage or other elements of said mammal'simmune system. Alternatively, the dermal augmentation kit comprises a 30gauge or smaller needle, a corresponding syringe, and separatecontainers containing the microspheres in dried form and thebiocompatible solvent. The dried sterilized microspheres and the solventare ready to be mixed for injection either in their respectivecontainers or in the syringe. These dermal augmentation kits are sterileand ready to use. The kits are designed in various forms based the sizesof the syringe and the needles and the volume of the injectablecomposition contained therein, which in turn are based on the specificskin deficiencies the kits are designed to treat.

EXAMPLES

The following non-limiting examples provide those of ordinary skill inthe art with specific preferred methods to treat conditions within thescope of the present invention and are not intended to limit the scopeof the invention. In the following examples various modes ofnon-systemic administration of a Clostridial neurotoxin can be carriedout.

Example 1 Botulinum Toxin Cosmetic Compositions

In a beaker containing 100 ml of demineralized water, 58 g of sodiumchloride and 27 g of sodium acetate are dissolved. 400 ml of glycerol isadded and then the pH is adjusted between 5.9 and 6.1. Then 90 g ofN-tris-hydroxy-methyl methylacrylamide, 35 mg ofdiethylaminoethylacryl-amide and 10 g of N,N-methylene-bis-acrylamideare added. The composition is heated at 60-70° C. and 100 mo of a hot300 mg/ml gelatin solution is added. The total volume of the mixture isadjusted to 980 ml by addition of hot water and then 20 ml of a 70 mg/mlammonium persulfate solution and 4 ml ofN,N,N′,N′-tetramethylethylenediamine are added.

This solution is poured into paraffin oil at 50-70° C. stirring. After afew minutes, the polymerization reaction of acrylic monomers ismanifested by an increase of temperature. The microspheres are thenrecovered by decanting, washed carefully, screened and sterilized in anautoclave in a buffered medium.

Those microspheres, after screen calibration, possess thecharacteristics desired for dermal augmentation.

The microspheres are combined with botulinum toxin type A (e.g., BOTOX®)in a lyophilized form, and are stored dry at −4° C. for several months.The microspheres and botulinum toxin type A are solubilized with salinebefore administration to an individual.

Example 2

The procedure of Example 1 is followed, using botulinum toxin type Binstead of botulinum toxin type A.

Example 3 to 7

The procedure of Example 1 is following using one of botulinum toxintypes C, D, E, F, and G instead of botulinum toxin type A.

Example 8

The procedure of Example 1 is followed with the addition of a secondbotulinum toxin other than type A.

Example 9 Use of Botulinum Toxin Type A and Swellable Microspheres toTreat Marrionette Lines

A 48 year old woman with marrionnette lines seeks treatment from herphysician. The woman inquires about BOTOX® injections. The physicianrecommends administration of a new product which utilizes both botulinumtoxin and swellable microspheres. The woman agrees. The composition ofExample 1 is injected into the depressor anguli oris muscle on each sideof the woman's mouth. Each injection site receives about 10 units ofbotulinum toxin. Within about 7 days, the marrionnette lines begin todisappear. The marionnette lines remain reduced for about 2 years afterthat single treatment.

Example 10 Use of Botulinum Toxin Type A and Swellable Microspheres toTreat Glabellar Lines

A 32 year old man with brow furrows seeks BOTOX® treatment from hisphysician. The physician recommends a new product which utilizes bothbotulinum toxin and swellable microspheres. The composition of Example 1is injected into the corrugator and procerus muscles of the man'sforehead. Each injection site receives about 5-10 units of botulinumtoxin. Within about 3 days, the glabellar lines begin to disappear. Theglabellar lines completely disappear in about 14 days and remain reducedfor about 1 year after that single treatment.

Example 11 Use of Botulinum Toxin Type A and Swellable Microspheres toTreat Crows Feet

A 57 year old man with crows feet resulting from years of sun exposureseeks treatment from his physician. The physician recommends a productwhich utilizes both botulinum toxin and swellable microspheres. Thecomposition of Example 1 is injected subdermally on either side of thepatient's eyes. Each injection site receives about 3 units of botulinumtoxin, with several injections made on either side of the eye. The crowsfeet disappear within about 10 days after treatment, and remain reducedfor six months.

Example 12 Use of Botulinum Toxin Type A and Swellable Microspheres forBrow Lift

A 60 year old woman presents with eyebrows extending below her browbone. Her physician recommends a product which utilizes both botulinumtoxin and swellable microspheres. The composition of Example 1 isinjected subdermally above each eye. Each injection site receives about10 units of botulinum toxin, with several injections made on either sideof the eye. The drooping of the brow is reduced within about 14 days,and is substantially alleviated for 1 year after administration.

In each of the examples 9-12 above a botulinum toxin type B, C, D, E, For G can be substituted for the botulinum toxin type A used above, forexample by use of 250 units of a botulinum toxin type B. The specificamount of a botulinum toxin (such as BOTOX® administered depends upon avariety of factors to be weighed and considered within the discretion ofthe attending physician and in each of the examples insignificantamounts of botulinum toxin enter appear systemically with no significantside effects.

The present compositions and methods may provide one or more of thefollowing advantages:

1. the injected compositions are not easily displaced within the tissuesin which they were originally injected,

2. the injected compositions are not readily eliminated eitherbiochemically or through macrophage or other elements of the immunesystem,

3. the compositions include materials of sufficient size to be injectedthrough 30 gauge or smaller needles,

4. the microspheres are flexible and not fragile, facilitating easyinjection without being broken,

5. the injected microspheres are not irregularly shaped and do not clumptogether,

6. the injected compositions provide enhanced duration of therapy orcosmetic improvements relative to materials without a neurotoxin,

7. the injected compositions provide enhancements in the therapeutic orcosmetic outcome due to the synergistic effects provided by theswellable microspheres and the neurotoxins, thus, the cosmetic defectscan be dramatically reduced or eliminated,

8. the cosmetic defect can be reduced or eliminated for at least abouttwo weeks to about six years upon use of the present compositions,

9. few or no significant undesirable side effects occur fromintramuscular (or intradermal or subdermal) injection or implantation ofthe Clostridial neurotoxin, and

10. the present methods can result in the desirable side effects of amore positive attitude, and an improved quality of life.

These benefits, whether alone or in combinations, enhance theeffectiveness of the treatment and are safe, more convenient andcomfortable for patients.

Although the present invention has been described in detail with regardto certain preferred compositions and methods, other embodiments,versions, and modifications within the scope of the present inventionare possible. For example, a wide variety of neurotoxins can beeffectively used in the methods of the present invention. Additionally,the present invention includes local administration methods to alleviatea cosmetic defect or deficiency wherein two or more neurotoxins, such astwo or more botulinum toxins, are administered concurrently orconsecutively. For example, botulinum toxin type A can be administereduntil a loss of clinical response or neutralizing antibodies develop,followed by administration of botulinum toxin type B. Alternately, acombination of any two or more of the botulinum serotypes A-G can belocally administered to control the onset and duration of the desiredcosmetic result. Furthermore, non-neurotoxin compounds can beadministered prior to, concurrently with or subsequent to administrationof the neurotoxin to proved adjunct effect such as enhanced or a morerapid onset of denervation before the neurotoxin, such as a botulinumtoxin, begins to exert its therapeutic effect.

My invention also includes within its scope the use of a neurotoxin,such as a botulinum toxin, and swellable microspheres in the preparationof a medicament for the treatment of a cosmetic defect or deficiency, bylocal administration of the composition.

All references, articles, patents, applications and publications setforth above are incorporated herein by reference in their entireties.

Accordingly, the spirit and scope of the following claims should not belimited to the descriptions of the preferred embodiments set forthabove.

1. A composition useful for treating a cosmetic defect in an individual,comprising a botulinum toxin component; and a microsphere componentcomprising a plurality of swellable microspheres.
 2. The composition ofclaim 1, wherein the botulinum toxin component is associated with themicrosphere component so that the composition is effective in augmentinga cosmetic feature of the individual by the combination of the swellingof the microspheres and by proteolytic activity of a botulinum toxin ofthe botulinum toxin component.
 3. The composition of claim 1, whereinthe botulinum toxin component comprises a botulinum toxin selected fromthe group consisting of botulinum toxins types A, B, C, D, E, F, G, andmixtures thereof.
 4. The composition of claim 1, wherein the botulinumtoxin component comprises only botulinum toxin type A.
 5. Thecomposition of claim 1, wherein the botulinum toxin component comprisesan amount of botulinum toxin in a range from about 1 unit to about50,000 units.
 6. The composition of claim 1, wherein the botulinum toxincomponent comprises an amount of botulinum toxin in a range from about10 units to about 2,000 units of a botulinum toxin type A.
 7. Thecomposition of claim 1, wherein the botulinum toxin component comprisesan amount of botulinum toxin in a range from about 100 units to about30,000 units of a botulinum toxin type B.
 8. The composition of claim 1being substantially free of a botulinum toxoid.
 9. The composition ofclaim 1, wherein the microsphere component has an average microspherediameter, and the average microsphere diameter after administration tothe individual is between about one to about four times greater than theaverage microsphere diameter before administration.
 10. The compositionof claim 1, wherein the microspheres comprise crosslinked polymers. 11.The composition of claim 10, wherein the polymers are hydrophilic. 12.The composition of claim 1, wherein the microsphere component is ahydrogel material.
 13. The composition of claim 1, wherein themicrospheres comprise at least one polymer selected from the groupconsisting of sodium acrylate polymer, acrylamide polymers, acrylamidederivative polymers or copolymers, sodium acrylate and vinyl alcoholcopolymer, saponification products of copolymer of vinyl acetate andacrylic acid ester, vinyl acetate and acrylic acid ester copolymer,vinyl acetate and methyl maleate copolymer, isobutylene-maleic anhydridecrosslinked copolymer, starch-acrylonitrile graft copolymer and itssaponification products, crosslinked sodium polyacrylate polymer, andcrosslinked polyethylene oxide.
 14. The composition of claim 1, whereinthe microspheres comprise a cell adhesion promoter.
 15. The compositionof claim 1, wherein the microspheres comprise cells provided on thesurface of the microspheres.
 16. The composition of claim 15, whereinthe cells are autologous cells.
 17. The composition of claim 15, whereinthe cells are selected from the group consisting of fat cells, musclecells, subcutaneous cells, dermal cells, epidermal cells, and mixturesthereof.
 18. The composition of claim 1, wherein the micropsherescomprise an agent selected from the group consisting of radio-pacifyingagents, contrast agents, targeting agents, and mixtures thereof.
 19. Thecomposition of claim 1, further comprising a carrier component.
 20. Thecomposition of claim 19, wherein the carrier component is an aqueouscomposition.
 21. The composition of claim 19, wherein the carriercomponent is saline.
 22. The composition of claim 1, wherein thebotulinum toxin component is associated with the microsphere componentso that the composition is effective in treating a cosmetic defect ofthe individual for a period of time ranging from about one month toabout six years after administration to the individual.
 23. Thecomposition of claim 1, wherein the botulinum toxin component isassociated with the microsphere component so that the botulinum toxinretains a enzymatic activity after passing through a needle of about 30gauge or smaller.
 24. A composition useful for treating a cosmeticdefect in an individual, comprising: a cosmetic defect treating amountof botulinum toxin type A; and a plurality of swellable microsphereseffective in treating a cosmetic defect of the individual.
 25. Thecomposition of claim 24, wherein the composition is an injectablecomposition effective in treating wrinkles.
 26. The composition of claim25, wherein the wrinkles are selected from a group consisting ofmarrionette lines, glabellar lines, crows feet, brow furrows, andcombinations thereof.
 27. The composition of claim 24, wherein thebotulinum toxin type A is provided in an amount effective in providing alonger lasting anti-wrinkle effect relative to a substantially identicalcomposition without a botulinum toxin.
 28. The composition of claim 24,further comprising at least one additional botulinum toxin selected fromthe group consisting of botulinum toxin types B, C, D, E, F, and G. 29.The composition of claim 24, wherein the plurality of microspheres havean average microsphere diameter, and wherein the average microspherediameter increases after injection into the individual from about onetime to about four times the average microsphere diameter prior toinjection.
 30. A method of treating a cosmetic defect, comprisingadministering the composition of claim 1 to an individual.
 31. Themethod of claim 30, wherein the cosmetic defect is a wrinkle.
 32. Themethod of claim 30, wherein the cosmetic defect is a condition selectedfrom the group consisting of marrionette lines, glabellar lines, crowsfeet, brow furrows, and combinations thereof.
 33. The method of claim30, wherein the administering comprises subdermally injecting thecomposition in the individual.
 34. The method of claim 33, wherein theadministering comprises injecting the composition through a needle nogreater than about 30 gauge.
 35. The method of claim 30, furthercomprising administering an additional amount of a botulinum toxin tothe individual.
 36. The method of claim 30, wherein the administeringcomprises injecting a composition comprising a botulinum toxin type A.37. The method of claim 30, wherein the administering is effective intreating a cosmetic defect for a longer time relative to administering asubstantially identical composition without a botulinum toxin.